The next item on our agenda this afternoon is the statement by the Cabinet Secretary for Health and Social Services on the parliamentary review of health and social care in Wales, and I call on Vaughan Gething.

Thank you, Deputy Presiding Officer. The establishment of the parliamentary review into the long-term future of health and social care in Wales was a key commitment in our programme for government, 'Taking Wales Forward', but this of course came from an early agreement with Plaid Cymru to establish the review. That commitment was further emphasised in our national strategy, 'Prosperity for All'.

I announced the setting up of an independent panel of experts in November 2016. That came on the back of cross-party agreement, both on the terms of reference and membership of that independent panel. Their interim report was published on 11 July last year. The panel has had 12 months to consider evidence and use their expertise to come to their recommendations. The final report, with those recommendations from the panel, was published earlier today.

The independent review panel has been chaired by Dr Ruth Hussey, a former Chief Medical Officer for Wales, and has consisted of a range of national and international experts, indeed, in the field of health and social care. I'd like to thank Ruth and her fellow panel members, and moreover everyone who has engaged with and given evidence to the panel for their time and commitment in producing this important report.

The terms of reference and scope for the review and its time frame were challenging. But, as we know, the challenges facing us need to be addressed urgently. The panel was asked to provide a report and recommendations on: how the health and care system might deliver improved health and well-being outcomes for people across Wales; how to reduce existing inequalities between certain population groups; and how best to enable the whole health and social care system to be sustainable over the next five to 10 years.

This review has been supported by all parties throughout the period. I know that the chair and panel members have continued to engage with opposition spokespeople, and the Chair of the Health, Social Care and Sport Committee throughout the review. I welcome the cross-party support for the review and the maturity of the constructive engagement between all parties and the panel.

The case for change was set out very clearly in the interim report. I haven’t heard anyone disagree with the need for change in order to meet the challenges facing us now and in the future. In fact, I've heard enthusiasm for making progress to tackle the combination of issues that face us. What is clear to me is that we need change and need to get started on that change sooner rather than later. We need a system that meets the needs of our population going forward, and one that is financially sustainable.

The panel has engaged with that wide range of stakeholders, including health and social care workers, clinicians, members of the public, and the third sector. There have been face-to-face meetings, citizen panels, focus groups, written evidence, meetings with specific groups of people—for example, older people’s groups—and direct questions and answers on social media with the panel.

The report recognises that front-line staff and decision makers want to move forward and make changes that improve both the quality of experience and outcomes for people. It also recognises there are lots of examples of good work in health and social care, including joint working together to deliver a seamless service to people. Perhaps most importantly, the report also says that in Wales we have the very real potential to overcome the challenges that we face. And the challenges we face continue to be ones that I and others have mentioned before: on funding, on the pace of service change and service performance, including my own desire to develop new clinically based outcome measures.

The expert panel has set out the vision for a seamless service for citizens, with new models of care underpinned by a new quadruple aim. Those aims are: to improve the population's health and well-being, with a focus on prevention; to improve the experience and quality of care for individuals and families; to enrich the well-being, capability and engagement of the health and social care workforce, and to increase the value achieved from funding health and care through improvement, innovation, use of best practice, and, of course, eliminating waste.

The goals of that quadruple aim are compatible with, and work alongside, the goals of both the Well-being of Future Generations (Wales) Act 2015, the Social Services and Well-being (Wales) Act 2014 and the principles of prudent healthcare. The panel recommends that each of those four goals should be pursued simultaneously. The new models proposed by the report are based on characteristics set nationally, but delivered locally, taking account of the views of citizens in their care, and using technology to improve access to services.

National standards are, of course, important, as is joined-up local decision making to meet the specific needs of local populations, taking account of, for example, the Welsh language or rurality as examples of factors. The report itself makes 10 key high-level recommendations across health and social care. Those recommendations cover people working in services and people using services, systems, innovation and technology; leadership, learning, culture and behaviour; and, of course, progress and pace at the heart of a future system.

The Welsh Government, NHS Wales, local government, housing and the third sector need to respond with pace and action. There will, of course, be hard choices as well as real opportunities over the coming months to transform the system that we currently have. However, we should not lose sight of the fact that this is an opportunity to shape the health and care system for the years and decades ahead. I hope that we can continue to work across services, across sectors, and, of course, across parties to secure the future of health and care in Wales.

I welcome the report from the review panel, and I will of course be considering the recommendations in more detail over the next few weeks. And in the spring I will publish a new long-term plan for health and social care that will take account of the recommendations in this report.

I, too, would like to welcome this report today. I found it to be an energising and enlightening read, and I'd like to thank Dr Ruth Hussey and the members of her team for all the hard work they've done, but also for the engagement that they have offered to me and to my Welsh Conservative colleagues in bringing forward ideas and thoughts, and recommending people to go and talk to to get to the truth of the matter. 

There's no doubt that health and social care faces some enormous challenges over these coming years—increasing demand, new drugs and technology and to have a better and more holistic understanding of what well-being is, and we have to combat all of that in the face of rising expectations from the general public. The case for change is compelling, and this is a very welcome analysis of the challenges we face. It pulls no punches and agitates for reform at pace, and I think one of the reasons we need to do this reform, Cabinet Secretary, is that I think it's very clear that we do not have a current vision for the NHS, and that there hasn't been sufficient attention on how to achieve that vision, how to achieve change and how to make best practice common practice. 

I note you intend to publish a long-term plan in the spring, and I would absolutely urge you not to be sidetracked by what I call the 'low-level stuff' and the lobbying that I'm sure you're going to start getting, because this is about the strategic direction of the health service going forward. Would you be able to tell us how long after the plan is published you intend to commence a programme of transformation? Anyone who's been involved in change throughout business will know that change cannot last for too long. Transformation programmes do need to be pushed at pace. Will you commit in the plan to reviewing the periods of maybe every year, every couple of years, every five years, to make sure that we are on track and are doing what we need to do? 

I think the report tackles the area of competence, and I think there's a real concern emerging by the panel and other stakeholders that we do not have enough people with the relevant experience and skills to run such an ambitious change programme. How do you intend to address this, Cabinet Secretary? Will you start recruiting for those people soon, otherwise any change programme that you may put forward in the spring is going to take even longer to get off the ground? 

In health, we have an independent sector, namely GPs. In social care, we have an independent sector, namely our valuable care home providers. We see the tensions today between the public sector and those independent sectors. Cabinet Secretary, how do you intend to address that in putting together your strategic plan and bringing those people on board to ensure that this is a whole NHS and a whole healthcare sector engagement? 

How will you be intending to bring on board the general public? Much was made of the general public in this review by Dr Ruth Hussey, and I'd like to understand the weight that you put down on that. 

Proceeding at pace is going to be a difficult thing. We need to bring on the health and care staff. We need to ensure we have training and a clear path forward for those people to understand how they are going to be engaged in building their and our NHS. Do you intend to put in place a strategic—I'm sorry, this is my last question, Deputy Presiding Officer—do you intend to put in place a strategic transformation team of experienced individuals with cross-cutting and collaborative skills, who will have the authority to drive the transformation across all of our health boards, and will they also eventually be able to look at the critical question—the elephant in the room that no-one can talk about or has talked about—which is how we are going to fund all of this, because the money is incredibly important? I do understand it wasn't part of the review, but without understanding how much money we have going forward to spend on health and social care, it might be very difficult to achieve some of these excellent objectives. 

Good review, Cabinet Secretary; please don't let it just sit on a shelf somewhere in Welsh Government and go nowhere, because this is good, good stuff. I'm very pleased to see it. 

Thank you for the response, and I'll try and respond briefly to each of the eight areas of questions that you've raised. And, of course, at the outset we agreed not to publish a new vision to replace 'Together for Health' because we're going to have a review. It would have been odd if I had said, 'Here is our view for the future of the health service, and then let's have the parliamentary review.' There's a trade-off in doing that. And at the outset I indicated there would be some things that we'd have to get on with and do before the review, and other things we'd need to wait for the review. I think it's that first point about when a programme for transformation will commence. Some things are already happening, but the review itself has recognised that it wants to see more of—. So, some of that transformation is in train. The challenge is perhaps the pace and the scale of that transformation. And as you'll know from having had a chance to read the report, they recommend having a transformation team in place for at least a year, to try and drive that change.

In terms of when we'll review that, well I do expect to review the report, both during the construction of the long-term plan for health and care that I've said we expect to be able to publish at the end of spring. That's a pretty tight timescale, but I think we need to maintain the momentum, so it doesn't sit on a shelf within the Government, or other people's libraries. And we'll need to think, as we publish the plan, about what timescales we'll then look at to measure our progress. An obvious one will be in a year's time, and we'll think about other waypoints to check on our progress. That goes into your point about both recruiting people to deal with transformation, and having a strategic transformation team.

We'll need to look at the current skills we have, both centrally, here within the civil service, and centrally, a leadership team in both the health service, but also the social care system as well. When you think of the people who we currently have, and how to drive that transformation, if we accept the recommendation about having a team, who are those people, where do we get them from, and where do the costs come from to actually pay those people to do the job, and their authority to properly engage with the service to drive improvement? Those are real issues for us to consider, as we deliver a plan, and then look to take that forward.

I take seriously your point about the engagement of health and care staff, and their training. That's obviously something that we need to look at. Innovation and improvement—well, certainly, the improvement activity often comes from training, from recognising that best practice needs to be standard and common practice, and how we look to have a learning environment, and a rich learning environment. And that comes into one of the key recommendations in the report as well.

On public engagement, I had a number of conversations with Lee Waters, and others, about whether the public would be genuinely engaged in the review. And they took that seriously: they had citizens panels and they took the opportunity to listen to and talk with the public. Part of our challenge is how we engage the public in a more regular conversation about health and care in any event, and in some of this, the social care sector is further ahead than the health service, and people are being more engaged in their choices. There's something about how the health service catches up with that, and equally how we have a more general debate about health and care, which doesn't rely on either a point of crisis or a point of real anxiety and controversy locally. Lots have been getting engaged in either their local service or a hospital service about something they disagree with or are concerned about. We need a broader and deeper engagement. To be fair, some of our health boards in Wales are better at doing that on a regular basis than others. So, again, that's a key point of learning and driving through, otherwise having the citizen be a more equal partner in making health and care choices is unlikely to happen, let alone the design of services.

And I think I've tried to deal with your point about staff training and engagement. I want to come back to your final point about money. We agreed across parties, in the terms, not to address money in this review. Because, if we'd done that, we could have easily spent a whole year just looking at how to fund and what to fund. These are controversial choices, and we all have different views on how we shall fund within a reducing resource base, which is objectively the case. The Government has a reducing resource base in real terms. The percentage of health and care spend continues to rise, as in our vote on the budget later today that puts more money into the health service. Our challenge must be: what is the long-term funding settlement going to be, and the requirement to do that? There's a different debate to be had there, about what individuals do to contribute to social care, for example, the funding of social care, the work that Gerry Holtham was doing with Mark Drakeford, my department, Huw Irranca, in looking at the long-term funding for social care. So, those questions can't be parked.

What we have to do is, to come up with a final point in the review and the quadruple aim: how do we nevertheless derive greater value from the Welsh public pound that we invest in these services? But, we'll continue to have to debate funding, what we expect to deliver from that, and what we're prepared to do in not spending that money in other parts of public services, if we choose to invest more of our funds in the health and social care system.

I'd also like to place on record my thanks to Ruth Hussey and her team for the way they conducted this review. And I think it has been a very timely look at the state of health and social care in Wales. I would say that, in that Plaid Cymru pushed the agenda on having this parliamentary review, and we've been only too pleased to play our part in being part of a discussion panel, every now and then, as the work progressed, to get to the point where we have now this report, which is food for thought. And I'll keep my questions fairly brief. I won't ask a long list of questions today, because I think the publication of this parliamentary review report is the start of a process. Now that we have the fruits of the labour of Ruth Hussey and her team, we have things and yardsticks that we can hold to Government to see how Government responds.

I think the central strength of what we have here is that statement in this report that we do not have a vision for the future of health and social care in Wales. And it's not overly egging a political point in saying that it is implicit, in that that there's an indictment of a governing party that has controlled the NHS in Wales for the best part of 19 years and still we don't have a vision. The urgency is shown in the timescale that Ruth Hussey wants to see the Government responding in. She wants to see now a consultation and a vision being published within a matter of three months.

So, the first question is: could you give us an idea of the level of consultation that Government will engage in in order to bring forth that vision? There are some specific elements where Ruth Hussey says she would like to see the patient voice being heard much clearer in decisions on the future of healthcare. The second question: how does that and the idea that the patient experience must be measured very, very well and carefully tally with proposals that Government has made on the abolition of community health councils, which is the body that measures patient experience specifically? Will you, therefore, put those plans on the shelf, because we have in this report a clear, clear suggestion that patient experience must still be measured in future? 

On workforce, I will make the comment that whilst here we have a call for a new vision, that new vision will involve implementing things that many of us have long called for, for example, making sure that we train adequately enough doctors. Therefore, I'd be interested in your comments on whether you now will be accelerating moves, for example, towards the establishment of a medical training centre in Bangor, because we have in this report emphasis on the need to make sure we have adequate and well-trained workers.

On money, yes, the financing of the NHS was not part of the remit, but I do remember Plaid Cymru being ridiculed before the last election for suggesting that £300 million-worth of savings, if you like, could be made through better use of technology and innovation within the NHS in order to re-invest in spending that money better within the health service. So, I'd be interested in your comments on that. 

So, this is a starting point, and I look forward to being told also by Government how we can measure whether Government is succeeding in responding to this important report. What will be the measure of success? 

Thank you for those questions. A couple of comments, and then I'll try and address, I think, your five specific areas of questions. I want to start by recognising, of course, the role of Plaid Cymru in this review coming into being. We tried before the last election to have cross-party agreement on a health and care review and there's something about timing in all of this and recognising timing, because actually within the last year of the last Government, it was difficult to get parties to agree to do it. And it's understandable why. There's no criticism of individual parties, but a year before the election it's difficult to get people to say, 'Let's be cross-party and work together.' We've taken that opportunity at the start of this term to start this process of having an independent review, agreeing on the terms and agreeing on the membership. We now need to make choices together as well. 

The challenge for all of us, in Government, of course, as well—. I quite enjoy having the responsibility of being in Government and I've got a responsibility to make choices now and in the future as well. But there is a central challenge to all of us as political representatives in what we choose to do and how we have the debate and how we make choices together about the future, because if we stop choices being made that is a choice in itself, and the report tells us that, in many ways, that is the biggest danger for the future of health and care. We've got to have the space, the vision, the ability and the willingness to make some difficult choices about the future, and that was a choice we made at the start, but not, as I said to Angela Burns—. We did not replace 'Together for Health' at the start of this term, because we were going to have this review instead, and that was the right choice to make and that's the comment the panel are making about having a vision. We need to have that vision—that is the long term plan that I've talked about for health and care—by the end of spring. That is what we want to provide, that vision for the future, to take forward the review and not, as Angela has suggested, leave it on a shelf in the Government.

And I guess on that point about engagement ahead of the long-term plan—your first question—we do expect to engage openly with stakeholders, within the health service, with different staff groups and different royal college representation as well. It's interesting how royal colleges themselves are actually welcoming and agitating for more change as well. That can be difficult for them and some of their members, as well as our broader trade union colleagues representing workers in the health service, but much more than that of course, our partners in local government and beyond. This has been deliberately a health and social care review. This isn't simply about the health service; it is about how health and social care are part of a broader system, with colleagues in housing as well. I expect them all to be interested in that future plan and, of course, the public as well. We want to have an open public engagement and voice within that long-term plan for the future.

In terms of your point about measuring patient experience, again, it is, of course, important as part of the quadruple aim about understanding how we measure patient experience and enhancing and valuing it. We need to find some measures that are useful to add real value to what we're measuring. Otherwise, the danger is that we simply measure numbers, and that always gets you back to activity, the volume of activity, the time in which something is done rather than the quality of what's done and someone's experience, and that's a bit more difficult. But I think it's more valuable in doing that as well.

I would politely disagree with you about not abolishing community health councils. If we wish to have a citizen voice, advocacy across our health and social care system, we actually need to have a new legislative footing for that group. You can't simply do it the way that CHCs are currently constituted, so you have to find a new way to constitute a new body. The discussion is about what powers and what responsibilities they have with the new system. You can paint it as abolition, but they're going to be replaced with a new body to work across the whole health and social care system, and I think that is the right thing to do. Indeed, the national Board of Community Health Councils in Wales agree that that's the right thing to do as well.

On workforce, we've been clear previously in our response on your specific points about medical training in north Wales, and I will of course bring forward a statement on the work that the three universities are already doing on how we equip more people more generally across the country to have a career in medicine and in particular how we deliver more medical training within north Wales.

On technology-led innovation and the figures, again, there is a range of people, both within this Chamber and outside, who recognise the real potential and, indeed, the real need to gain more from technology in delivering innovation and improvement that will deliver real value. It's not just about shaving a few pound signs off, but actually recognising the way that people live their lives and make choices. Actually, the health service needs to catch up with that. Again, there are some parts of social care where, working together, we've got to design systems that actually work together and can talk to each other to again make it easier for the citizen. We should not expect an individual who has health and care needs to navigate their way through a complex system. We have to make it easier for them to do so.

Finally, on your point about measures, I've indicated that we need to take seriously the review and respond to it properly, but there will be a need, and I recognise that now to come back, at the very least within a year, to look at the progress that we've then made, as well as being open to scrutiny, not just in the normal way in the Chamber and through the Health, Social Care and Sport Committee, but from a Government point of view to think seriously about the recommendation in the review that, each year, we provide an annual update from the Government and the health service and the social care system on where we think we are, the challenges we still have and what else we need to do. I think that's a worthwhile suggestion that we do need to give serious consideration to, because I think that would provide some of the clarity that you yourself have suggested we should look to provide.

Can I first of all thank the Cabinet Secretary for his statement on this very important report, the recommendations of which are welcome to those of us who have worked in and with our health and social care system over a number of years? I'd also like to add my thanks to Ruth Hussey and her team for the work they've put in to delivering it. I'm going to try not to repeat a number of the points that others have made. There are just two short points that I want to make.

Firstly, the recommendations of this review have, without a doubt, placed a huge responsibility on this whole Assembly to rise to the challenge that's been set. The report makes it clear the scale of the challenges that we need to face. In truth, it's a daunting responsibility, because every Member of this Assembly understands, or should understand, that changes in the service are needed, but attempting to make those changes can be difficult when local opposition arises to changes and when political opportunism overtakes the objective consideration. We've already heard in this debate a couple of cheap political shots. I have to say, Rhun, I don't think that was necessary in terms of the consensual way in which we were trying to have a discussion and debate about this particular report. 

But changes are needed and they're needed against the backdrop of ongoing financial pressures, so it's incumbent on all of us to ensure that the services are delivered more effectively and possibly in a very different way. 

Angela raised the point about the funding for all of this, but I think we need to be very clear that there's no more money coming out of this. There's no more money coming down from Westminster for us to fund the services that we have or the services that we want, going into the future, but we can't continue—we can't afford to continue, sorry—investing in models of health and social care that don't respond to the future needs that are and have been well known and understood for a very long time. 

My second point—

Are you coming to a question?

Yes, I am. I am, yes.

[Inaudible.]—questions. It is a statement and therefore it should be questions.

I've got a series of questions that—

Well, no. You've got questions now, or, you know—

Okay. Well, my second point is about the process of negotiating necessary change and the need to involve the staff in that. I know from my own experience that that change does require patience and persuasion and communication, but, most of all, it involves taking people with you, because to resist change does lead to stagnation, both for the people the service has to deliver to and the people who work within it.

What I would ask, Cabinet Secretary, because we've heard a lot about the vision in this report, and I would say that the report, actually, is the vision, it sets out the vision, so would you agree that we all need to be clear that this is our vision and direction of travel and that we must be unwavering in our commitment to that? And would you further agree that if we are to achieve the quadruple aim for all, as set out in the report's recommendations, then staff who work in the service must be involved in the change and their voices must be listened to if we are to achieve the objectives of the review?

Thank you for those points. I recognise someone who was previously on the other side of the table as the former Unison head of health—other health service trade unions are, of course, available. But you were right that this is a challenge for all of us, for all of us in this place. Because, as I said, choosing not to do something is still a choice, and I think it's a really important point that the report really highlights and follows through from the case for change, and you said it yourself, that this is about delivering services differently and sometimes delivering different services. And, to do that, you can't invest in everything that we do now, as you said. That does mean that we need to do things differently, and that's difficult, because most people want to be able to add to things as opposed to saying, 'You've got to decide, within the financial envelope, what are we not going to do, as well as what are we going to choose to do and to enhance what we do in the future.' That will be difficult and we need to understand that that's difficult for people in the services, difficult for some local communities that are attached to services—people do get very attached to bricks and mortar. Even though they say they're not, the reality is that people do. You can understand some of that emotional attachment to long-running services and to people they trust, but if we can't get through having a programme for change and transformation as the report sets out then we will manage a declining service, and that can't be acceptable for any of us in any party.

On your specific points about the direction of travel and the quadruple aim and staff, I think the report does set a direction of travel for us and it's about how we deliver that and how we choose priorities within Government, with the service, with local government partners and others as well, to deliver against the very real challenges and the direction that the report sets out. It is crucial, in doing so, that we do take seriously the part of the quadruple aim that is about the engagement and enriching the way staff do their jobs. People who enjoy their jobs tend to provide better care in health, social care and other services and sectors too. And that's not easy, given the pressure on workers in health and social care, especially—we rarely talk about it, but social care workers, who are not paid a significant amount of money to do jobs that are difficult, demanding and very physical, often, and the credence we give to those people, and the way we hardly ever talk about them—. And when we do, actually, there's still quite a lot of stigma around the social care sector as well, so the work that Rebecca Evans started off leading on, which Huw Irranca-Davies is now taking forward, on raising the esteem of people within that sector, is crucial to delivering the aims within this report and, in particular, that point you make about the quadruple aim and engaging staff in the future of the whole service.

Thank you for your statement, Cabinet Secretary. I would also like to place on record my thanks to Dr Ruth Hussey and the panel for the excellent work they've undertaken for their report and their recommendations. The report starkly lays out in black and white the actions we need to take if we are to deliver sustainable health and care now and in the future. Dr Hussey and her team have done their job admirably. It's now up to us to do ours. We know the challenges, and the parliamentary review has outlined the direction of travel, so, therefore, we have to deliver the necessary changes. It won't be easy, as change is never easy, but we can't continue to deliver NHS services in the same way as we did 70 years ago. We all acknowledge the need for change. It is the task of each and every one of us here in this Chamber to have an adult conversation with our constituents on the need for change, to push forward the principles of prudent healthcare, and to support clinically led changes to services. Cabinet Secretary, it is your job to ensure that the necessary changes are actually delivered on the ground. The need for change is clear, and the NHS cannot afford to wait five, 10, 15 years for these changes to come on stream. The NHS and social care need to adapt now if we are to have any chance of meeting future demand for the services.

Cabinet Secretary, investment in staff is one of the biggest challenges facing us, particularly if we are to focus on local care delivery. Do you have any plans to increase the primary care workforce, particularly the number of GP training places in the immediate future?

Digital technology will have a key role to play in future delivery plans. How do you plan to transform the way IT is delivered to the NHS? We have to ensure that the money we invest in our NHS is actually used to deliver these services. We, therefore, have to eliminate waste, and this week we have learned about the extraordinary level of fraud taking place with the European health insurance cards, with other EU citizens claiming free healthcare using fake EHIC cards. Today, we learned of the level of damages and legal fees paid out by NHS trusts for negligence over the last five years. Cabinet Secretary, what is your Government doing to eliminate fraud in our NHS and to reduce the level of medical negligence?

I look forward to your new, long-term plan for health and social care and working with you to deliver an NHS that is fit for the future. Thank you.

I thank the Member for most of what she said. There were some points where we'd have to part company on agreement. I don't actually think that fraud related to the European Union and EHIC cards is a big issue that will undermine the future of the service. The challenge that we face in both need and demand, in having a rising and ageing population, in the challenges over money, I do not think are ones where we can say that European citizens, whether legitimately or otherwise, are going to undermine the future of the service. It's not covered in the report, it's not been a significant area of interest, but, of course, I would not want the service to be taken advantage of. There's a difference between saying, 'I don't mind; people can do what they like,' and saying that that's the biggest challenge we face. So, I expect them to play by the rules. Where people don't, I expect the appropriate action to be taken.

On your point about medical negligence, well, this is a constant challenge for any and every health service. Actually, the response is how we improve the quality of care that is delivered, how that improvement action is a real part of what the service does and not just a fig leaf. That's why we need to look again at our own improvement programmes—1000 Lives has done significant work in improving the quality of care and decision making across the health service. We need to look again at that as an improvement programme, the challenge the report sets us, and the quadruple aim, and look at delivering greater value. So, those are things that we absolutely do need to do.

In terms of your point about transforming IT delivery, I think that's been covered in other comments and questions. It's a key challenge for the health and care system, how we take greater advantage of what technology allows us to do and actually catch up with the way citizens currently live their lives.

And your final point about increasing the primary care workforce—we are in a better place than other parts of the UK, in some ways, because we've actually met our numbers and we've overfilled the places we had on the GP training numbers, which you mentioned specifically. The challenge now is to understand what more do we need, and that isn't just a question for the Government. It's also part of the reason we set up Health Education and Improvement Wales—to try and get that broader based understanding of planning for a future workforce, making sure we have the places available, and then the difficult choices about money. Because, if I had the opportunity and ability to, I would invest more money in the future of the health and care workforce. But I have to live within the means that this Assembly votes for me to be able to do that, in the budget that this place will, I hope, choose to pass later on today. So, funding is always a challenge, but we cannot avoid the reality: we need to deliver greater value than the resource we put into our whole system.

Cabinet Secretary, there is some very useful, high-level analysis some very useful, high-level analysis in the report, but I think what's most helpful are the detailed recommendations in the annex section, in particular recommendation 7, on innovation, technology and infrastructure. I was very pleased to see the role of digital woven right throughout the report, and its potential to release resource and improve the patient experience. My question is, having read last week's report by the Wales Audit Office in conjunction with today's report, there are a series of direct and indirect criticisms of the National Health Service Wales Informatics Service, NWIS, and I have real doubts about their ability, both in terms of capacity and capability, to deliver this radical agenda—not least the finding from the Wales Audit Office that they've been partial and overly positive in reporting progress to the Welsh Government. So, I just ask for your reflections on the nature of the criticisms in both reports, and whether or not you can now have confidence in NWIS, as currently constituted, to deliver this agenda, and what you can put in place to make sure we achieve the potential of digital.

Thank you for the comments. You've been consistent in taking an interest in this area, both formally and informally in conversations that we've had. I think the first point that I'd make is that, for all the criticism that's made of NWIS, they have actually delivered a number of things that we're really proud of. If you think about the response in terms of security, the differential where we invested in a system that they've delivered, if you think about Choose Pharmacy, their creating of that and then delivering in partnership with the service, that will make a real difference, and, actually, be directly in this space of making better use of information between healthcare professionals, changing the point of focus where people can go and get that advice and support as well.

So, even with the positive things they've done, it's fair to reflect on where we think they could do better. I recognise the comments that are made in the report and in the Wales Audit Office report and in other suggestions as well, about does it have the capability and the capacity, as it's currently constituted, to do all that we need it to do. Well, I don't think it would be fair to say that it does, because we would place unfair, I think, expectations on NWIS, as it currently is, to do all that we want to do in terms of investing in and releasing the capacity of IT to transform the way that we deliver services and the way that citizens themselves engage in health and care services.

And I also recognise the points about governance and thinking again about whether it's in the right place, whether we could do more, and thinking about how that governance is released. I've indicated previously that I intend to do this, and the report has helpfully not said we need to do something different, in that we do need to carry on looking at that capability, that capacity, and where we find it: how much should be in-house within NWIS, how much should be working with other partners, and how much should be a formal partnership. Because we can't pretend that we can do all of that in the one place. If we try to do that, I think we'll fail. It has to be a different partnership, and we're going to have to set those ambitions and set ourselves a priority, and that may mean we need to look again at the resourcing we put into this area, as well, of course, as the governance and oversight, both for Members, people in the health service, in the care system, and of course here in Government as well.

Thank you very much, Cabinet Secretary. Thank you.